Medical Cost Advocate

What Medical Cost Advocate does

Medical Cost Advocate (MCA) is a US-based healthcare cost reduction and advocacy firm founded in 2006 by Derek Fitteron and headquartered in Wyckoff, New Jersey. The company helps individuals, families, employers, insurers, third-party administrators, and corporate payers reduce out-of-pocket medical costs and navigate the complexity of the US healthcare system, claiming typical bill savings of 20-50% across more than 80,000 members served.

MCA's core product set comprises five lines: Bill Negotiation (expert review and negotiation of post-care medical bills on a no-upfront-cost, performance-based model), Concierge Advocacy (ongoing dedicated advocacy for individuals and families on a subscription/recurring basis), On-Call Advocacy (on-demand health insurance and billing advisory for employer groups), Payer Claim Negotiation (out-of-network cost containment for insurers, TPAs, and corporate payers), and US Medical Tourism (facility review and fee negotiation for international patients accessing US providers). The underlying technology is a secure customer self-service portal for bill submission and case tracking, layered on top of a labor-intensive negotiation and advisory practice delivered by a team of 11-50 seasoned experts with 20-30 years of healthcare experience each, including licensed brokers, multilingual advocates, and legal specialists.

MCA operates a hybrid go-to-market: a direct-to-consumer self-serve portal for individuals and families, paired with enterprise field sales targeting employer groups, insurers, TPAs, wealth advisors, family offices, and brokers, plus a small professional-services motion for inbound medical tourism. Revenue mixes transactional percentage fees (consumer bill negotiation, payer claim negotiation) with recurring subscription fees (concierge and on-call advocacy). In August 2024, MCA was merged into Emry Health, a benefit navigation company launched by Goodroot in 2022, with founder Derek Fitteron becoming Founder and CEO of the combined entity.

Name

Medical Cost Advocate

Legal name

Medical Cost Advocate, Inc.

Website

https://medicalcostadvocate.com

Company type

Private

Founded year

2006

Operating status

Acquired

Headcount range

11–50 employees

Short description

Medical Cost Advocate is a US healthcare cost reduction and advocacy firm that negotiates medical bills and provides concierge health-insurance navigation for individuals, families, employers, insurers, and payers, serving over 80,000 members with typical savings of 20-50%.

Ownership category

akta.pro rank

NAICS

Other Individual and Family Services (624190)

SIC

Services-Misc Health & Allied Services, Nec (8090), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Patient Advocacy, Navigation & Access to Care (BPAGACAH)

akta.pro secondary industry

Medigap Member Support & Care Navigation (Advocacy/Concierge) (HLAEADAH)

Keywords

• Medical bill negotiation
• Healthcare cost advocacy
• Claim negotiation services
• Healthcare benefits navigation
• Medical cost reduction

Headquarters

HQ city

Wyckoff

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Others

Revenue model

1. Bill Negotiation Services: Negotiation of medical bills on behalf of individuals and families to reduce healthcare costs. Services include expert review, negotiation with providers, and payment arrangement assistance.
2. Concierge Advocacy Services: Ongoing advocacy services for families with dedicated experts optimizing healthcare decisions, insurance advisory, and billing assistance.
3. On-Call Advocacy for Groups: On-demand health insurance and billing experts for employer groups helping employees realize savings and reduce total cost of care.
4. Payer Claim Negotiation: Cost containment solutions for insurers, TPAs, and corporate payers for out-of-network claims negotiation.
5. US Medical Tourism Services: Facilitating international patients to access US healthcare with facility review, fee negotiation, and provider assistance.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels4 records

Core offering

Medical Cost Advocate (MCA) provides healthcare cost containment and advocacy services, including negotiating medical bills, reviewing and appealing insurance claims, coordinating benefits, and offering on-demand concierge healthcare support. Services are delivered by licensed insurance and billing advocates to individuals, families, employers, insurers/TPAs, wealth advisors, and international patients, typically producing 20–50% reductions on medical bills. The firm has served more than 80,000 members and reports over $5 million in client healthcare savings over the past three years.

Product overview

Medical Cost Advocate is a healthcare cost reduction and advocacy company offering a suite of services including Bill Negotiation, Concierge Advocacy, On-Call Advocacy, Payer Claim Negotiation, and US Medical Tourism. The company provides personalized healthcare concierge services to over 80,000 members, including initial pretreatment guidance, post-care bill review and negotiation, pharmacy guidance, and insurance consultation. In August 2024, MCA merged into Emry Health under the Goodroot community, combining its concierge-focused services with Emry's employer and employee benefit navigation platform. Services range from individual bill negotiation (20-50% typical savings) to enterprise-level cost containment for insurers and corporate payers.

Differentiator

Problem solved

Functional benefit

Products and services

• Bill Negotiation Outcome-based negotiation of medical bills for individuals, families, and organizations, covering in-network, out-of-network, cash-pay, and prospective procedures. Advocates negotiate with providers to reduce balances, with fees contingent on achieved savings.
• Concierge Advocacy Subscription-based white-glove healthcare advocacy that combines comprehensive benefits navigation, insurance consultation, and executive-level support. Designed for individuals, families, and high-net-worth clients served via wealth advisors and family offices.
• On-Call Advocacy On-demand healthcare advocacy service giving members access to licensed advocates for billing, claims, and provider questions. Sold primarily to employers as a per-employee-per-month (PEPM) benefit through the Emry Health/Goodroot channel.
• Payer Claim Negotiation B2B claim negotiation and cost-containment service for insurance carriers, third-party administrators (TPAs), and corporate payers. The team reviews and negotiates in-network, out-of-network, and disputed claims, with performance-based fees tied to recovered or saved dollars.
• US Medical Tourism Coordination and negotiation service for international patients seeking medical treatment in the United States. MCA negotiates upfront cash-pay rates, coordinates providers, and supports patients through treatment, billing, and post-care.

Quantifiable outcome

• Typical savings of 20-50% on medical bills
• +3 more outcomes

Named customers3 records

Segments6 records

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Two partnerships are on record, tiered core.

• GoodrootcoreStrategic or Co-development Partner · 5 August 2024Goodroot is a community of companies dedicated to improving access and affordability in healthcare. MCA was merged into Goodroot's benefit navigation company Emry Health in August 2024. The combined companies are now a center of excellence for helping clients navigate the U.S. healthcare system.
• Emry HealthcoreStrategic or Co-development PartnerMCA merged into Emry Health, a benefit navigation company launched by Goodroot in 2022 leveraging MCA founder Derek Fitteron's expertise. Emry helps employees understand benefits, utilize them appropriately, and make cost-effective healthcare choices.

Scale indicators4 records

Recent moves5 records

Expansion highlights5 records

Broad incumbents

• Conifer Health Solutions: Large incumbent providing revenue cycle management, population health, and value-based care services to health systems and payers; overlaps with MCA in payer-facing claim negotiation and cost containment.
• Accolade: Established, publicly-traded personalized advocacy and virtual care company serving employers and health plans; competes in healthcare navigation/advocacy but at significantly greater scale and breadth.
• Included Health: Broad incumbent combining virtual care (Doctor On Demand) with navigation and advocacy (Grand Rounds), serving employers and health plans with overlapping capabilities to MCA's services.

Emerging players

• Rightway Health: Tech-enabled healthcare navigation and pharmacy benefits platform targeting employer-sponsored populations; overlaps with MCA's employer-focused advocacy and benefits navigation offerings.
• Solera Health: Emerging player connecting patients to chronic disease prevention and management programs via a curated network of community providers — an adjacent healthcare navigation model with employer/payer distribution overlap.
• Garner Health: Emerging player using data to steer patients to high-value providers and reduce healthcare costs; competes in the cost-containment and provider-selection space that overlaps with MCA's advocacy and prospective negotiation services.

Direct peers

• Quantum Health: Direct peer providing healthcare navigation and care coordination services primarily to self-funded employer health plans, with similar advocacy and cost-containment value propositions.
• Emry Health (Goodroot): Benefit navigation company launched by Goodroot in 2022 that merged with MCA in August 2024; serves employer-sponsored populations with live benefit navigation and virtual assistants, directly overlapping with MCA's on-call advocacy and concierge services.
• Health Advocate (a Teladoc Health company): Direct peer offering healthcare advocacy, bill negotiation, and benefits navigation services to employers, employees, and individuals — closely mirroring MCA's core offerings.

Others

• GoodRx: Adjacent consumer-facing healthcare cost platform offering prescription price transparency and discount services; not a direct competitor, but operates in the same consumer healthcare cost-reduction conversation in which MCA engages.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/medicalcostadvocate
• LinkedInlinkedin.com/company/medical-cost-advocate-inc.

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Medical Cost Advocate